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Specific OSCE stuff > Abdominal > Flashcards

Abdominal Flashcards

1
Q

On general inspection in chronic liver disease

A

Malnourished
Bruising (impaired clotting)
abdominal distension
jaundince if obvious

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2
Q

Hands/Arms in chronic liver disease

A 
CLubbing
Palmar erythema
Dupuytren's contracture (alcohol)
Liver flap in hepatic encephalopathy
Leukonychia due to hypoalbuminemia
Koilonychia due to low iron
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3
Q

eyes/FACE in chronic liver disease

A

Jaundiced sclera if decompensated
ANEMIA
Parotid enlargement if liver failure cuased by EtOH

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4
Q

Neck in chronic liver disease

A

raised JVP due to fluid overload secondary to hypoalbuminemia

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5
Q

chest in chronic liver disease

A

reduced hair
gynaecomastia
spider naevi

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6
Q

causes of nail clubbing (ABDO)

A

IBD, especially Chron’s
cirrhosis
coeliac

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7
Q

hand signs in chronic liver disease

A

leuconychia
palmar erythema
dupuytren’s in EtOH

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8
Q

CAUSES OF ABDOMINAL DISTENSION

A 
Flatus
Faeces
Fetus
Fat
Fluid (ascites, ovarian cyst)
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9
Q

characteristics of spleen

A
  1. in the right hypochondrium
  2. has a notch
  3. cannot get above it
  4. moves on respiration
  5. dull to percussion
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10
Q

causes of splenomegaly

A

Infection: viral (EBV), bacterial, protozoal (malaria, schisstosomiasis), parasitic (Hydatid)
Haematological: (LYMPHOPROLIFERATIVE AND MYELOPROLIFERATIVE) leukemia (CLL/CML),lymphoma, myelofibrosis, polycythemia, haemolytic anaemia
Portal HTN
Autoimmune: SLE, Rheumatoid arthritis (Felty’s)
Sarcoid,
Metabolic: amyloid, storage diseases
CYsts

MUST MAKE POINT TO CHECK ALL THE LYMPH NODES

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11
Q

Causes of hepatomegaly

A

RHF: smooth, tender, large, +/-pulsatile (tricuspid regurg), raised JVP
Infection: EBV, hepatitis, malaria
Malignancy: mets or primary, myeloma, leukaemia, lymphoma
Others: sickle cell disease, porphyria

MUST MAKE POINT TO CHECK ALL THE LYMPH NODES

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12
Q

Polycystic kidney disease findings

A

Bilateral, irregular abdominal masses
1/3 have cysts in liver, pancreas
Increased blood pressure (clues» Betablockers?)
+/-AV fistulae/ rutherford-morrison scar for kidney transplant/scar in the abdomen

FBC (↑Hb) U+Es(↑urea), US abdo, screen family members
CT head for berry aneurysms

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13
Q

Renal mass DDx

A 
polycystic kidney disease
renal cyst
renal malignancy
hydronephrosis
pyelonephrosis
perinephric abscess
renal TB
Rena cell carcinoma (male >40 years)
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14
Q

general inspection in IBD findings
hands
face/mouth

Legs

A 
CUshingoid appearance from steroids
Nail clubbing
Leuconychia/koilonychia
Mouth ulcers
Skin/eye inflammation

Pyoderma gangrenosum
Erythema nodosum

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15
Q

What are Terru’s nails?

A

signify chronic liver disease

They are white proximally but dark red distally

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16
Q

Causes of palpable liver without hepatomegaly?

A 
Lung hyperinflation (eg in COPD)
Riedel's lobe
Gallbladder pathology
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17
Q

When does spleen become palpable?

A

At least twice its size

18
Q

Key features of portal HTN

A
  1. ascites
  2. splenomegaly
  3. caput medusae
  4. oesophageal varices
19
Q

Lump examinations

A
  • Site • Texture • Fixed/ mobile
  • Size • Tenderness • Pulsatility
  • Shape • Transillumination • Consistency
20
Q

commonest non-fatal condition causing splenomegaly and jaundice

A

hereditary spherocytosis

21
Q

General features in renal transplant

A

Signs of previous renal replacement therapy (forearm fistula or PD scar)
Evidence of immunosuppression (gum hypertrophy (ciclosporin), cushingoid appearance, skin tumours))
Mass in the iliac fossa, with overlying J shaped scar

22
Q

Causes of ESRF in the UK

A 
Diabetes 
Glomerulonephritis
CHronic pyelonephritis
Polycystic kidneys
Interstitial nephritis
HTN
23
Q

DDX for masses in iliac fossa

A 
Chron's disease
Primary malignancy
Iliac TB
Appendicular abscess
Caecal carcinoid
24
Q

How would you define jaundice?

A

Jaundice is the yellowish discolouration of the skin, sclera and mucous membranes due to hyperbilirubinaemia

25
Q

How is bilirubin produced?

A 
#Bilirubin is the end product of haem metabolism
80% of bilirubin is produced from the breakdown from haemobglobin in RBCs and 20% from the breakdown of haem in myoglobin and cytochromes.
26
Q

What causes jaundice?

A

The causes can be classified as Pre-hepatic , hepatic and post-hepatic causes.
Prehepatic: when bilirubin production is increased through exercise, haemoglobin breakdown (haemolysis) or myoglobin breakdown (rhabdomyolisis). Haemolysis can be intrinsic where the RBC is defective or extrinsic, where RBC is normal.
Hepatic: bilirubin increases in any process in which cell necrosis reduces liver’s ability to metabolize and excrete bilirubin such as:
Acute hepatitis and liver cirrhosis of any cause, enzymopathies such as Gilbert’s syndrome and Crigler-Najjar syndrome.

Posthepatic: when there is an obstruction of biliary drainage system causing their reflux to blood. Within the liver: PBC, PSC, drugs. Extrahepatically: gallstones, pancreatic Ca, parasites.

27
Q

How would you investigate patients with jaundice?

A

FBC, LFTs, hepatoglobulins, reticulocytes, coom’s test, clotting profile, autoimmune screen, viral screen. Urine test. Further: USS abdo, CT abdo, ERCP, MRCP, liver biopsy

28
Q

What is Gilbert’s syndrome?

A

Autosomal dominant condition resulting in reduced levels of the enzyme glucuronyltransferase. This results in reduced conjugation of bilirubin.→ lvls of unconjugated bilirubin ↑. Precipitated by stress, fasting, infection. Condition is benign and asymptomatic, no treatment necessary.##What is Dubin-Johnson syndrome?
Autosomal recessive defect in molecular transporters responsible for excreting conjugated bilirubin out of hepatic cells. → ↑levels of conjugated bilirubin and pigmentation of the liver

29
Q

Physical findings in chronic lliver disease

A

Findings:
Jaundice
Hands: clubbing, leuconychia, hyperpigmentation, excortiation, purpura, xantomata, dupytren;s contracture, palmar erythema, hepatic flap
Trunk: hepato-, spelno-megaly, ascites, caput medusa, spider naevi, gynaecomastia
Other: scanty body hair, testicular atrophy, ankle oedema, tattoos, needle marks →? IVDU

30
Q

Cirrhosis is what?

A

It’s a consequence of chronic liver disease. Characterised by a replacement of normal liver tissue by fibrous scar tissue and regenerative nodules, which leads to a loss of liver function.

31
Q

Complications of liver cirrhosis?

A 
Ascites
Spontaneous bacterial peritonitis
Coagulopathy
Portal HTN
Hepatic encephalopathy
Hepatorenal syndrome
HCC
32
Q

What can precipitate hepatic encephalopthy>

A 
Infection
Drugs: diuretics and sedatives
Upper GI bleed
Abdo paracentesis
Surgery
33
Q

What is autoimmune hepatitis?

A

More common in females. Associated with autoimmune conditions such as type 1 diabetes, thyroiditis, RA, scleroderma, IBD.
Presents with fatigue, RUQ pain, arthralgia, abnormal LFTs
Tx with immunosuppressive drugs (steroids, azathioprine)
80% are associated with HLA B8/DRw£, ANA, anti-smooth muscle antibodies and polyclonal hypergammaglobulinaemia.

34
Q

Alpha-1-antitrypsin deficiency is what?

A

Defective production of alpha-1-antitrypsin, which is a protease inhibitor. There are several forms and degrees of deficiency. Deficiency results in cirrhosis, increased risk of HCC, emphysema. Tx by liver and lung transplantation.

35
Q

What is hep B virus?

A

It is a DNA virus
Transmitted perenterally or by sexual contact. Complications include liver cirrhosis and HCC. Tx with interferon-alpha is successful in about 40% of cases. SEs include flu-like sx, depression, fatigue, haematological abnormalities. Other drugs: lamivudine, adefovir, entecavir.

36
Q

What is hep C virus?

A

It is an RNA virus. Main routes of transmission: through needles in IVDU, blood transfusions, blood products. Sexual transmission is low. Complicaitons: liver cirrhosis, HCC. Tx: interferon-alpha and ribavarin.

37
Q

When can liver be palpable without being enlarged?

A

Emphysema – overinflated lungs#
Reidel’s lobe
R-sided pleural effusion

38
Q

What is Budd-Chiari syndrome?

A

Characterised by thrombosis of the hepatic veins, resulting in: abdo pain, ascites, hepatomegaly
Jaundice usually absent
No cutaneus features of liver disease as the onset of liver failure is rapid
Liver is smoothly enlarged and tender

39
Q

What are the causes of Budd-Chiari?

A

Hypercoagulabloe states: pregnancy, contraceptive pill, PRV, essential thrombocythaemia, antiphospholipid syndrome, Protein C, S or antithrombin III deficiency
HCC
Hepatic infections such as hydatid disease
Renal and adrenal tumours
Congenital venous webs

40
Q

What do you want to do if you fin splenomegaly?

A

I would like to complete my examination by CHECKING FOR LYMPHADENOPATHY IN THE AXILLAE, CERVICAL AND INGUINAL AREAS.

Specific OSCE stuff (7 decks)

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